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Pastoral

As church leaders we often find ourselves confronted with any of a wide range of pastoral issues where we feel we lack expertise.  The features in this section will give you many suggestions for what you might do (at least until the experts arrive!)

You can see the full range at livingleadership.squarespace.com/growing-in-pastoring-

Miscarriage

[Your Name Here]

Written by Anonymous.  

You can download the PDF of this resource here. 

When a miscarriage occurs, it can be hard to know what to do or say; partly because, for friends who haven’t been through miscarriage, it’s difficult to understand what it’s like. 

What does ‘miscarriage’ mean?  Miscarriage is the loss of a baby at any point up to the 24th week of pregnancy (at which point a baby is considered `viable`). Any loss over 24 weeks is referred to as a ‘stillbirth’ (and is registered both as a birth and a death).

Miscarriage is normally divided into two categories, ‘early’ and ‘late’. An ‘early’ miscarriage occurs up to 12 weeks. A ‘late’ miscarriage occurs after 14 weeks. Different organisations and health care trusts refer to loss between 12 and 14 weeks in different ways (both as early and late). Either way the experience of loss can be profound.

It is very difficult to establish just how common miscarriage is – it is highly likely that the majority of miscarriages occur before the woman realises she is pregnant. However, it is thought that around one in four pregnancies end in miscarriage, often before the pregnancy is shared with others. This makes the issue of providing pastoral support even more difficult.

In general, the older a woman is, the higher the risk of miscarriage.

There are many reasons why miscarriages occur; however, in most cases tests will not be carried out to establish the cause of miscarriage unless a women has experienced ‘recurrent miscarriage’, i.e. three or more miscarriages. (Some NHS trusts view this as three or more miscarriages with no live births.) Often the first sign of a miscarriage is vaginal bleeding. However women can also find out at a scan appointment that their baby has died when a heartbeat cannot be detected.

No two losses are the same, and a couple who experience more than one miscarriage may react in different ways to the losses.  Some of the issues which can add to the loss are:

  1. Recurrent loss
  2. Late miscarriage
  3. Fertility problems

However, all miscarriage is a loss, and that loss should never be minimised.

Different hospitals and NHS trusts have different procedures for helping women experiencing miscarriage. Those offering a ‘best practice’ model should ensure that the remains are dealt with in a dignified manner (many hospitals offer a cremation), although parents are at liberty to arrange their own service (either burial or cremation). This option is often not shared with parents at point of crisis, and therefore parents need to know to ask for the baby’s remains to be preserved. Unfortunately, there are still situations in which clinicians dispose of baby remains as clinical waste, particularly in early pregnancy loss.

With later pregnancy loss, it may well be possible for the parents to view and/or hold the baby, for hand and foot prints and photographs to be taken. Decisions about this need to happen quite quickly and this can be a very difficult period, as the parents have to make tough decisions at a time when they may well be quite traumatised. Again the parents may well have to push the hospital for this service – some offer it, others don’t.

It can be helpful for the parents to meet the baby – it enables them to recognise the loss in a person, rather than just a clinical event. The advantage of having hand and footprints, and photographs taken, is that it provides a memorial which can be looked at or not at a later stage when the parents are working through their loss.

Some issues miscarriage raises

·         Many people face miscarriage alone because the loss occurs before knowledge of the pregnancy is shared with others. This can lead to huge feelings of isolation.

·         It can be difficult explaining to other children what has happened.

·         Miscarriage is the loss of a human life, but can often be viewed merely as a clinical event.

·         The woman can experience huge hormonal changes in her body after the loss of the pregnancy as her body returns to its pre-pregnant state. It is also possible after a miscarriage for her breasts to leak milk, which can be particularly distressing. Further, a woman may experience post-natal depression following a miscarriage.

·         There are likely to be spiritual consequences – questions such as ‘Why did God allow this to happen’ are commonplace. It can be very difficult to maintain spiritual disciplines such as Bible reading and prayer.

·         The Bible makes no direct reference to miscarriage; there are a number of references to infertility, but only ones which have ‘happy endings’.

·         Miscarriage can raise questions about the eternal state of the unborn child.

·         Church can be a difficult place, particularly when there are lots of references to ‘family’ events, services etc. Particular services can be emotional trigger points – the dedication, baptism of a child, birth announcements, mothers’ or fathers’ days.  A ‘normal’ worship service or homegroup can cause many ‘gulp’ moments; reminders about the goodness and faithfulness of God (both from Scripture and in song) can seem quite unreal when everything inside is screaming ‘Why?’  Passages such as Matthew 7:11 – ‘If you, then, though you are evil, know how to give good gifts to your children, how much more will your Father in heaven give good gifts to those who ask him’ - can seem very hard to process.

·         This in turn can easily lead to feelings of guilt, or to a situation in which the couple feel they have to pretend to be in a different place from where they really are.  Another consequence may be to avoid church or homegroup completely.

·         Returning to where the miscarriage occurred can also be difficult, especially if this happened in the local hospital.  Follow-up may well occur in the local early pregnancy unit, and it can be difficult to be surrounded by other pregnant women, knowing that you have lost your child.  Ensuring that the woman doesn’t have to face this alone is really important.  If it’s possible for the partner to accompany her,  that is obviously best, but otherwise it is really helpful if someone from the church’s pastoral care team, or a friend, can go with her.

Things which may help

·          Practical support – looking after other children for periods of time over the first few days or weeks.

·         Providing meals, particularly if accompanied by the statement: ‘I’d like to bring you dinner this week – would Monday or Thursday suit you best?’ This is particularly helpful with later miscarriages or where surgery has been required, and the convalescent period is longer. Just having to deal with everyday tasks such as cooking and cleaning can be exhausting; in particular anything which requires decision-making skills, even over something as simple as preparing dinner.

·         Physical presence – a hug, an arm around the shoulder.  Both parents need to know that others care about the pain they are experiencing.  There can be a real physical ache to hold the child which has been lost, and physical contact with others is really important.

·         A listening ear – and not just for the first few days.  It can (and probably will) take weeks, months, years to be able to work through the grief processes.

·         An understanding that they will not ‘get over it’, ‘get back to normal life’.  Life has changed forever. The mother and father have lost a child.

·         Don’t avoid the couple. You may well not know what to say, and that is OK – even acknowledging it can be helpful. Low-key social events can be helpful too – invite them over for a cup of coffee in the evening. Ask questions like ‘How are you doing today?’, ‘How has this week been?’ – that gives them the opportunity to say as much or as little as they wish.

·         Be aware that there will be many trigger points, over the next year especially – if antenatal care had already been arranged, the dates of expected scans, the due date, the date when the woman was hoping to start maternity leave.  All of these will bring back difficult memories.

Useful resources

Secular:

www.babyloss.com

www.miscarriageassociation.org.uk

www.tommys.org/miscarriage

Christian:

www.careconfidential.com. Care Confidential offer a series of pregnancy support centres which provide counselling and advice for patients in pregnancy crisis.  Some centres also provide support for women who have experienced miscarriage.

www.careforthefamily.org.uk/bpn/  The Bereaved Parents’ Network.  This offers a pairing service for bereaved parents.  It also has a printable sheet of suggested `do’s and don’ts` for friends and relatives to know how best to support them:   http://www.careforthefamily.org.uk/pdf/services/BPN/BPNTipsSheet.pdf

http://www.careforthefamily.org.uk/supportnet/?view=5  This provides a link to a helpsheet on miscarriage by Care for the Family.

http://www.undertherainbow.org.uk/  A website written for Christians who have suffered miscarriage or neonatal death, including a number of Bible studies.  Also contains helpful links to further resources.

Christian books:

Nick and Malcolm Cameron, It’s OK to Cry  (Christian Focus , 2005; ISBN 1845500776) -  the story of one couple’s walk through miscarriage and infertility.

Pam Vredevelt, Empty Arms (Multnomah, ISBN 1576738515) - written from an American perspective and needs to be read through an English filter, but contains much helpful material.

Lizzie Grayson, Keziah  (Sovereign World, ISBN 1852405406) - the story of a couple living through pregnancy who knew their daughter would probably not survive birth.

Pablo Martinez and Ali Hull, Tracing the Rainbow: Working Through Loss and Bereavement  (Authentic, ISBN 1850784876) - a very helpful book covering issues of loss and bereavement, helpful for both sufferers and those who would help them. At the end of the book there is a very helpful interview with John and Alison Risbridger on the death and stillbirth of their two sons.